Blood Transfusions, like all other medical treatments, should be prescribed only after a careful consideration of the risks vs. the benefits of the procedure. While there is much in the literature concerning the potential risks associated with transfusions, little is known about the indications and benefits of red cell transfusions. The '10/30' (hemoglobin/hematocrit) threshold for transfusion has been widely used until recently. The applicant is currently funded by NIH and AHCRR to perform two different but highly complementary research projects. The Anemia and Surgery study will determine the risk of death in relationship to perioperative hemoglobin levels in 2,000 patients who refuse blood transfusions for religious reasons. The Variation of Surgical Blood Transfusion study will assess the effect of variation of blood transfusion practices on the risk of death in 10,000 surgically repaired hip fracture cases. While the studies will provide important insights into transfusion practice and outcomes, the known limitations of observational research necessitates the use of a randomized clinical trial to truly define the risks and benefits of transfusions. During this fellowship the applicant will 1) acquire training and experience with clinical trials 2) will develop a research protocol to study the efficacy of blood transfusions in the perioperative setting and 3) begin organizing the clinical trial.